Provider Demographics
NPI:1114909744
Name:NATHAN, MILTON FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:FRED
Last Name:NATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMIBURG-CENTERVILLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342
Mailing Address - Country:US
Mailing Address - Phone:937-866-0637
Mailing Address - Fax:937-866-6713
Practice Address - Street 1:4000 MIAMISBURG-CENTERVILLE RD.
Practice Address - Street 2:STE 100
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342
Practice Address - Country:US
Practice Address - Phone:937-866-0637
Practice Address - Fax:937-866-6713
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00456207R00000X, 207RC0000X
VA0101268378207RC0000X
OH35040194207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0422699Medicaid
OH000000004497OtherANTHEM BC/BS
060013547OtherRAILROAD MEDICARE
OH0422699Medicaid
OH000000004497OtherANTHEM BC/BS
OH0439491Medicare PIN
OH0439492Medicare UPIN
060013547OtherRAILROAD MEDICARE